<#import "/common/function.ftl" as fn>
<@fn.header _title="">
	<script language="javascript" type="text/javascript" src="${base}/web/js/JScript.js"></script>
</@fn.header>
<body onload="load();">
<form action="" method="post" id="">
	<div class="rightBk">

        <div class="title">
            <div class="title-middle">
                <div class="title-left">
                </div>
                <div class="title-caption">
                    申请人代表基本信息</div>
                <div class="title-right">
                </div>
            </div>
        </div>
        <table class="table1">
            <colgroup class="GridCaption" style="width:12%; background-color: #eef3f7;" ></colgroup>
            <colgroup style="width: 20%;" ></colgroup>
            <colgroup class="GridCaption" style="width:12%; background-color: #eef3f7;" ></colgroup>
            <colgroup style="width: 20%;" ></colgroup>
            <colgroup class="GridCaption" style="width:12%; background-color: #eef3f7;" ></colgroup>
            <colgroup style="width: 20%;" ></colgroup>
            <tr>
            	<td>申请人姓名</td>
                <td>
                	<input name="familyMemberName" type="text" id="Text6" class="input4" value="${(fm.name)!}"/>
                </td>
            	<td>证件类型</td>
           		<td>
	            <select name="familyMemberIdType" id="ddlCertType0" class="select1">
	                	<#list idTypes as idType>
                        	<#if (idType.code==fm.idType)>
                        		<option value="${idType.code}" selected>${idType.name}</option>
                        	<#else>
                        		<option value="${idType.code}">${idType.name}</option>
                        	</#if>
                    	</#list>
            	</select>
            	</td>
            	<td>证件号</td>
            	<td><input name="familyMemberIdNumber" type="text" id="txtCertCodeJSF0" class="input4" value="${fm.idNumber}"/></td>
            </tr>
            <tr>
                <td>性别</td>
           		<td>
		            <select name="" class="select1">
		                <option value="01" selected="selected">男</option>
		                <option value="02">女</option>
	            	</select>
            	</td>
                <td>民族</td>
                <td>
                    <select name="familyMemberNation" id="Select8" class="select1">
                        <#list nations as nation>
                        	<#if (nation.code==fm.nation)>
                        		<option value="${nation.code}" selected>${nation.name}</option>
                        	<#else>
                        		<option value="${nation.code}">${nation.name}</option>
                        	</#if>
                    	</#list>
                    </select>
                </td>
                <td>出生日期</td>
                <td><input name="" type="text" class="input4" maxlength="50" onClick="WdatePicker()" /></td>
            </tr>
            <tr>
                <td>政治面貌</td>
                <td>
                    <select name="familyMemberPoliticalStatus" id="Select8" class="select1">
                    	<#list politicalStatusList as _politicalStatus>
                        	<#if (_politicalStatus.code==fm.politicalStatus)>
                        		<option value="${_politicalStatus.code}" selected>${_politicalStatus.name}</option>
                        	<#else>
                        		<option value="${_politicalStatus.code}">${_politicalStatus.name}</option>
                        	</#if>
                    	</#list>
                    </select>
                <td>婚姻状况 </td>
                <td>
                    <select name="familyMemberMaritalStatus" id="Select8" class="select1">
                        <#list maritalStatusList as maritalStatus>
                        	<#if (maritalStatus.code==fm.maritalStatus)>
                        		<option value="${maritalStatus.code}" selected>${maritalStatus.name}</option>
                        	<#else>
                        		<option value="${maritalStatus.code}">${maritalStatus.name}</option>
                        	</#if>
                    	</#list>                     
                    </select>
                </td>
            </tr>
            
            <tr>
			    <td>固定电话</td>
                <td>
                	<input name="familyMemberPhone" type="text" id="Text6" class="input4" maxlength="16" value="${fm.phone}" />
                </td>
                <td>移动电话 </td>
                <td>
                	<input name="familyMemberMobile" type="text" id="txtMobileJSF0" class="input4" maxlength="16" value="${fm.mobile}"/>
                </td>
                <td>邮政编码</td>
                <td><input name="" type="text" class="input4" /></td>
            </tr>            
            <tr>
                <td>户籍所在地</td>
                <td colspan="3">
                    <select id="Select6" class="select1">
                        <option selected="selected" value="01">沈阳市</option>
                    </select>
                    <select name="familyMemberHouseholdDistrictCode" id="Select7" class="select1">
                      <#list citys as city>
                        	<option value="${city.code}">${city.name}</option>
                      </#list>
                    </select>
 	                派出所
                </td>
                <td>户籍类型</td>
           		<td>
	            <select name="" class="select1">
	                <option value="01" selected="selected">户籍类型数据</option>
            	</select>
            	</td>
            </tr>       
            <tr>
                <td>现居住地址 </td>
                <td colspan="4">
                    <select id="addrCity" class="select1">
                        <option selected="selected" value="01">沈阳市</option>
                    </select>
                    <select id="addrArea" class="select1">
                      <#list citys as city>
                        	<option value="${city.code}">${city.name}</option>
                      </#list>
                    </select>
                    <select name="familyMemberLivingDistrictCode" id="addrStreet" class="select1">
                      <#list streets as street>
                        	<option value="${street.code}">${street.name}</option>
                      </#list>
                    </select>
                    <input name="familyMemberLivingAddress" type="text" id="txtMobileJSF0" class="input4" onclick="this.select()" maxlength="50" value="${fm.livingAddress}" />
                </td>
            </tr>

            <tr>
                <td>现居住地开始居住时间</td>
                <td>
	                <#if (fm.startDateLiving!=null)>
	                    <input name="familyMemberStartDateLiving" type="text" id="Text6" class="input4" value="${fm.startDateLiving?string('yyyy-MM-dd')}" onclick="WdatePicker()" />
	                <#else>
	                    <input name="familyMemberStartDateLiving" type="text" id="Text6" class="input4" onclick="WdatePicker()" />
	                </#if>
                </td>
                <td>文化程度 </td>
                <td>
                	<select name="familyMemberEducation" id="txtMobileJSF0" class="select1">
                      <#list educations as education>
                      		<#if (education.code==fm.education)>
                        		<option value="${education.code}" selected>${education.name}</option>
                        	<#else>
                        		<option value="${education.code}">${education.name}</option>
                        	</#if>
                      </#list>
                    </select>
               </td>
               <td>健康状况</td>
                <td>
                	<input name="familyMemberHealthStatus" type="text" id="txtCertCodeJSF1" class="input4" value="${fm.healthStatus}"/>
                </td>
            </tr>

            <tr>
                <td>劳动能力丧失状况</td>
                <td>
                <select name="familyMemberLaborLossStatus" id="txtMobileJSF0" class="select1">
	                <#list laborlost as ll>
	                	<#if (ll.code==fm.laborLossStatus)>
	                        <option value="${ll.code}" selected>${ll.name}</option>
	                    <#else>
	                        <option value="${ll.code}">${ll.name}</option>
	                    </#if>
	                </#list>
                </select>
                </td>
                <td>残疾等级</td>
           		<td>
	            <select name="" class="select1">
	                <option value="01" selected="selected">残疾等级数据</option>
            	</select>
            	</td>
                <td>所患主要疾病名称</td>
                <td><input name="" type="text" class="input4" /></td>
            </tr>
        </table>
        <div class="marginTop15 alignCenter">
            <img src="${base}/web/img/btnSave.gif" alt="" />
            <img src="${base}/web/img/btnCancel.gif" alt="" />
            <img src="${base}/web/img/btnNext.gif" alt="" />
        </div>
    </div>
</form>
</body>
</html>
